epilepsiaEpilepsy and paroxysmal conditionsЭпилепсия и пароксизмальные состояния2077-83332311-4088IRBIS LLC10.17749/2077-8333/epi.par.con.2022.090epilepsia-793Research ArticleORIGINAL ARTICLESОРИГИНАЛЬНЫЕ СТАТЬИStereoelectroencephalography in pre-surgical evaluation of patients with drug-resistant focal epilepsyСтереоэлектроэнцефалография в прехирургическом обследовании пациентов с фармакорезистентной фокальной эпилепсиейhttps://orcid.org/0000-0002-8710-6742БалацкаяА. С.BalatskayaA. S.

Балацкая Александра Сергеевна – невролог отделения нейрохирургии

Москва

Alexandra S. Balatskaya – MD, Neurologist, Department of Neurosurgery

Moscow

drbalatskaya@gmail.comhttps://orcid.org/0000-0002-2713-5904ПедяшН. В.PedyashN. V.

Педяш Никита Витальевич – нейрохирург отделения нейрохирургии

Москва

РИНЦ SPIN-код: 4659-3419.

Nikita V. Pedyash – MD, Neurosurgeon, Department of Neurosurgery

Moscow

RSCI SPIN-code: 4659-3419

https://orcid.org/0000-0001-6468-5350ГоловтеевА. Л.GolovteevA. L.

Головтеев Александр Леонидович – невролог

Москва

Alexander L. Golovteev – MD, Neurologist

Moscow

https://orcid.org/0000-0002-2899-0734КалыбаеваН. А.KalybaevaN. A.

Калыбаева Назгуль Ашимбековна – невролог

Москва

Nazgul A. Kalybaeva – MD, Neurologist

Moscow

https://orcid.org/0000-0002-0770-2983УтяшевН. П.UtyashevN. P.

Утяшев Никита Павлович – невролог отделения нейрохирургии

Москва

Nikita P. Utyashev – MD, Neurologist, Department of Neurosurgery

Moscow

https://orcid.org/0000-0003-0506-003XОдениязоваМ. А.OdeniyazovaM. A.

Одениязова Мадина Анварбековна – невролог отделения нейрохирургии

Москва

Madina A. Odeniyazova – MD, Neurologist, Department of Neurosurgery

Moscow

https://orcid.org/0000-0002-2784-302XБроновО. Ю.BronovO. Yu.

Бронов Олег Юрьевич – к.м.н., заведующий отделением рентгенорадиологии

Москва

Scopus Author ID: 57215892759;

РИНЦ SPIN-код: 7429-7993.

Oleg Yu. Bronov – MD, PhD, Head of Department of Radiology

Moscow

Scopus Author ID: 57215892759;

RSCI SPIN-code: 7429-7993

https://orcid.org/0000-0003-2974-1462ЗуевА. А.ZuevA. A.

Зуев Андрей Александрович – к.м.н., нейрохирург, заведующий отделением нейрохирургии

Москва

РИНЦ SPIN-код: 9377-4574.

 

Andrey A. Zuev – MD, PhD, Neurosurgeon, Head of Department of Neurosurgery

Moscow

RSCI SPIN-code: 9377-4574

Федеральное государственное бюджетное учреждение «Национальный медико-хирургический центр им. Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииРоссияPirogov National Medical and Surgical CenterRussian FederationНеврологическая клиника Epilepsy CenterРоссия“Epilepsy Center” Neurological ClinicRussian Federation202227072022142183194Copyright © Balatskaya A.S., Pedyash N.V., Golovteev A.L., Kalybaeva N.A., Utyashev N.P., Odeniyazova M.A., Bronov O.Y., Zuev A.A., 20222022Балацкая А.С., Педяш Н.В., Головтеев А.Л., Калыбаева Н.А., Утяшев Н.П., Одениязова М.А., Бронов О.Ю., Зуев А.А.Balatskaya A.S., Pedyash N.V., Golovteev A.L., Kalybaeva N.A., Utyashev N.P., Odeniyazova M.A., Bronov O.Y., Zuev A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.epilepsia.su/jour/article/view/793Background

Background. Surgical treatment has shown its effectiveness for patients with drug-resistant focal epilepsy: resection or disconnection of the epileptogenic zone leads to relief from epileptic seizures. However, in some cases non-invasive examination may not be sufficient for localization of epileptogenic zone boundaries. Hence, such patients undergo invasive encephalography (EEG) to clarify zone location accounting for seizure development.

Objective

Objective: to evaluate effectiveness of invasive stereo-EEG in the diagnostics of drug-resistant focal epilepsy.

Material and methods

Material and methods. The data collected from 65 patients who underwent stereo-EEG during pre-surgical examination for pharmacoresistant focal epilepsy were retrospectively analyzed within the period of 2016–2019. According to the results of magnetic resonance imaging (MRI), 34 patients had MRI-negative forms of epilepsy, and 31 patients had MRI-positive forms with multiple structural changes in the brain or discrepancies between electro-clinical data and MRI findings.

Results

Results. Based on the information obtained by stereo-EEG, 49 patients (75.4%) underwent resection operations. In 16 (24.6%) cases surgical treatment was not carried out due to detected bilateral epileptogenic zone, the lack of convincing data on its location or detecting an epileptogenic zone in a functionally significant region. In 44 operated patients, the follow-up comprised more than 12 months; it was not possible to contact 5 patients. Engel outcomes: I class – 27 (61.3%) patients, II class – 7 (15.9%), III class – 4 (9.1%), IV class – 6 (13.6%). As a result of stereo-EEG, hemorrhagic complications developed in 2 (3.1%) patients: epidural hematoma in 1 case (1.5%), and intracerebral hematoma in 1 case (1.5%). No persistent neurological deficit was noted during continued monitoring.

Conclusion

Conclusion. The method of stereo-EEG is effective for determining the epileptogenic zone boundaries in patients with drug- resistant focal epilepsy.

Актуальность. Хирургическое лечение показало свою эффективность у пациентов с лекарственно-устойчивой фокальной эпилепсией: удаление или дисконнекция эпилептогенной зоны приводит к избавлению больного от эпилептических приступов. Однако в части случаев неинвазивных обследований бывает недостаточно для локализации границ эпилептогенной зоны. Таким пациентам проводится инвазивная электроэнцефалография для уточнения расположения зоны, ответственной за развитие приступов.Цель: оценить эффективность инвазивной стереоэлектроэнцефалографии (сЭЭГ) в предоперационном обследовании пациентов с фармакорезистентной фокальной эпилепсией.Материал и методы. Ретроспективно проанализированы данные 65 больных, которым с 2016 по 2019 гг. была проведена сЭЭГ в ходе прехирургического обследования по поводу фармакорезистентной фокальной эпилепсии. По результатам магнитно-резонансной томографии (МРТ) 34 пациента имели МР-негативные формы эпилепсии, 31 – МРпозитивные формы с множественными структурными изменениями головного мозга или расхождениями между электроклиническими данными и МРТ-находками.Результаты. На основании полученной при сЭЭГ информации 49 (75,4%) пациентам были выполнены резекционные операции. В 16 (24,6%) случаях хирургическое лечение не проводилось в связи с выявлением двусторонней локализации эпилептогенной зоны, отсутствием убедительных данных о ее расположении или обнаружением эпилептогенной зоны в функционально значимой области. У 44 прооперированных больных отслежен катамнез дольше 12 мес, с 5 пациентами связаться не удалось. Исходы по классификации J. Engel: I класс – 27 (61,3%) пациентов, II класс – 7 (15,9%), III класс – 4 (9,1%), IV класс – 6 (13,6%). В результате проведения сЭЭГ геморрагические осложнения развились у 2 (3,1%) больных: по 1 (1,5%) случаю внутричерепной гематомы и субдуральной гематомы. Стойкого неврологического дефицита в последующем не отмечено.Заключение. Метод сЭЭГ эффективен для определения границ эпилептогенной зоны у пациентов с фармакорезистентной фокальной эпилепсией.

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The authors declare that there are no conflicts of interest present.